![]() ![]() ![]() ![]() ECAP components in ESR are produced by the synchronous activation of multiple neuronal fibers in the dorsal column of the spinal cord (He et al. 2022) to recently introduced closed-loop control based on motion/position sensors and/or evoked compound action potential (ECAP) sensing following stimulation (Mekhail et al. These range from the classical mapping of paresthesia during trial stimulation (Al-Kaisy et al. Several approaches have been developed to optimize the electrode placement and stimulation parameter selection of EES with the goal of reducing variation in and increasing therapeutic effectiveness of EES. Although lead migration can be confirmed through clinical imaging, there is currently no clinically available method to detect and flag the possibility of lead migration for EES automatically and continuously which would allow for decreased loss of efficacy. Variations in the effect of EES to control pain can be attributed to multiple factors, such as initial placement or later migration of the electrode contacts, patient position, and the functional state of the neuronal circuitry (Mekhail et al. 2011) however, several studies suggest that additional segmental and supraspinal mechanisms are involved in EES-induced analgesia (Gilbert et al. Activation of the large-diameter fibers in the dorsal columns is thought to inhibit pain transmission via gating within the dorsal horn (Zhang et al. ![]() Despite this clinical adoption, the local neural substrates responsible for the therapeutic effects of EES, and consequently the mechanisms of action to control pain, are poorly understood. Although SCS is commonly used to refer to the clinical application of treating chronic pain, we use the term EES which is more specific regarding electrode location and in relation to the treatment of chronic pain and sensorimotor disorders. Several research studies recently demonstrated that the EES is helpful in restoring motor functions for patients with complete paralysis (Harkema et al. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy.Įpidural electrical stimulation (EES) the most common type of spinal cord stimulation (SCS) has been used for several decades to manage chronic pain (Shealy et al. These findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Here, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure the accumulative local potentials from large populations of neuronal fibers during EES. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR™ waveforms), evoked muscle response, stimulation artifact, and cardiac response. MethodĮpidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects. Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. ![]()
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